BASE-LINE CHARACTERISTICS, NATURAL-HISTORY, AND RISK-FACTORS TO PROGRESSION IN EYES WITH STAGE-2 MACULAR HOLES - RESULTS FROM A PROSPECTIVERANDOMIZED CLINICAL-TRIAL
Jw. Kim et al., BASE-LINE CHARACTERISTICS, NATURAL-HISTORY, AND RISK-FACTORS TO PROGRESSION IN EYES WITH STAGE-2 MACULAR HOLES - RESULTS FROM A PROSPECTIVERANDOMIZED CLINICAL-TRIAL, Ophthalmology, 102(12), 1995, pp. 1818-1828
Purpose: The purpose of this study is (1) to determine baseline charac
teristics and natural history of immature full-thickness macular holes
, (2) to describe progression and resolution, and (3) to present new a
spects of pathogenesis of idiopathic macular hole. Methods: The author
s analyzed 41 eyes with stage 2 macular holes (37 patients) in a multi
centered prospective randomized trial; 19 eyes were randomized to obse
rvation (versus surgery) and had more than 12 months of follow-up, all
owing determination of the natural course. Baseline and subsequent exa
minations included best-refracted visual acuity (Early Treatment of Di
abetic Retinopathy Study, potential acuity meter, Pelli-Robson contras
t sensitivity, and Bailey-Lovie reading vision), of clinical examinati
ons, photography, and fluorescein angiography. Result: Mean Snellen vi
sual acuity was 20/66 at baseline. Centric holes usually had a small b
reak (201 mu m average mean diameter) with a dark yellow ring and with
out significant retinal elevation. Eccentric holes had a high maximum/
minimum diameter ratio (mean, 1.88 +/- 0.7) and an incomplete cuff of
subretinal fluid or yellow ring. Posterior vitreous detachment prevale
nce was 32% (8/25) in the centric hole group and 0% (0/16) in the ecce
ntric hole group (P < 0.05). For the 19 eyes with 12 months of followu
p, progression rate to stage 3 (or 4) was 74% (n = 14). The diameter o
f the stage 2 holes increased significantly between baseline and 12 mo
nths (P < 0.001). Progression rate to stage 3 was 100% (8/8) in the ey
es with pericentral hyperfluorescence (PCH) and 55% (6/11) in eyes wit
hout PCH (P < 0.05). Enlargement occurred in 100% of eccentric holes a
nd 60% of centric holes (P = 0.09). Different progression patterns in
eccentric and centric holes suggest different mechanisms of pathogenes
is. Conclusion: Eccentric and centric stage 2 macular holes may have a
different pathogenesis. Most stage 2 macular holes, especially with P
CH (P < 0.05) or eccentric holes, progressed to stage 3 or 4. In addit
ion to purely tangential traction, some component of obliquely oriente
d anteroposterior vitreous traction component may be important for pat
hogenesis of senile macular holes, particularly eccentric stage 2 macu
lar holes.